Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Clin Transplant. 2021 Mar;35(3):e14199. doi: 10.1111/ctr.14199. Epub 2021 Jan 3.
The prognosis of patients with acute leukemia relapsed after allogeneic hematopoietic stem cell transplantation (HSCT) is dismal. We aimed to evaluate the outcomes and prognostic factors of the second HSCT (HSCT2) in acute leukemia patients relapsed after the first HSCT (HSCT1). We analyzed 80 patients who received HSCT2 for relapsed acute leukemia in two Korean institutes. All but four patients received HSCT2 from a donor other than matched sibling donor: an unrelated donor (URD) in 30 and a familial haploidentical donor (FHD) in 46. Forty-four patients (55.0%) were in complete remission (CR) or CR with incomplete count recovery (CRi) at HSCT2, and the median time from HSCT1 to relapse was 9 months. The 2-year overall survival (OS) and event-free survival (EFS) were 21.0% and 17.5%, respectively. The outcomes were similar between URD and FHD. Multivariate analysis demonstrated that disease status (active disease vs. CR/CRi) at HSCT2 and remission duration after HSCT1 were independent prognostic factors for OS and EFS after HSCT2. HSCT2 from URD or FHD was feasible in patients with acute leukemia relapsed after allogeneic HSCT. Also, our study confirmed two critical prognostic factors; disease status at HSCT2 and remission duration after HSCT1.
异基因造血干细胞移植（HSCT）后复发的急性白血病患者的预后较差。我们旨在评估首次 HSCT（HSCT1）后复发的急性白血病患者进行第二次 HSCT（HSCT2）的结果和预后因素。我们分析了在两个韩国机构中接受 HSCT2 治疗的 80 例复发急性白血病患者。除了 4 例患者外，所有患者均接受了非匹配同胞供体以外的供体的 HSCT2：30 例为无关供体（URD），46 例为家族单倍体供体（FHD）。44 例（55.0%）在 HSCT2 时处于完全缓解（CR）或不完全血细胞计数恢复的 CR（CRi），从 HSCT1 到复发的中位时间为 9 个月。2 年总生存率（OS）和无事件生存率（EFS）分别为 21.0%和 17.5%。URD 和 FHD 的结果相似。多变量分析表明，HSCT2 时的疾病状态（活动疾病与 CR/CRi）和 HSCT1 后缓解持续时间是 HSCT2 后 OS 和 EFS 的独立预后因素。在异基因 HSCT 后复发的急性白血病患者中，URD 或 FHD 的 HSCT2 是可行的。此外，我们的研究还证实了两个关键的预后因素；HSCT2 时的疾病状态和 HSCT1 后缓解持续时间。
